Healthcare Provider Details

I. General information

NPI: 1356091086
Provider Name (Legal Business Name): RAPHAELLA MICHELLE DELLAVALLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAPHAELLA MICHELLE HOLLAND

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 N BROAD ST ROOM 001A
PHILADELPHIA PA
19140-4106
US

IV. Provider business mailing address

3500 N BROAD ST RM 1A
PHILADELPHIA PA
19140-4106
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-7198
  • Fax:
Mailing address:
  • Phone: 215-707-2433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD488429
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: